1. History of Operating Room
Before the Operating Room: The early surgeons were either priests,الكهنة magicians, physicians or barber-tradesmenالحلاق who understood anatomy and were comfortable with the common practices of amputation and trephinationنقب .

6. Trephination is perhaps the oldest of surgeries that we know.
The practice was probably originally performed for spiritual and magical reasons, and was performed by kings, priests and magician-physicians.
The Law Code of Hammurabi  (1700 BC) called for a surgeon’s hand to be cut off if the life of a person of high social order was lost
The Egyptian physician-surgeons became specialists, some concentrating on the head, others eyes, yet others on the abdomen. They had extensive knowledge of anatomy.
Egyptian surgical instruments were some of the most sophisticated to be found until well after the Middle Ages.
Indian physicians were thus confronted with a large number of patients with a problem. They learned the detailed anatomy and the surgical techniques that would lead to the development of both ENT (ear nose and throat) surgery and plastic surgery.

9. حمورابي هو ملك من السلالة الأولى التي حكمت مدينة بابل، وكون امبراطورية سامية و قد قام حمورابي بنشر الحضارة البابلية و ثقافتها في البلاد التي فتحها و عني عناية شديدة بإدارة المملكة و ضبطها و قام بمشاريع عديدة بخاصة مشاريع الري فنشر الرخاء في البلاد كما عنى عناية خاصة بالشؤون الدينية و العدل.
قانون حمورابي هو أحد أشهر الأمثلة على المبدأ القديم “Lex talionis”، أو قانون القصاص، نوع من العدالة الإنتقامية مرتبطة بالمقولة “العين بالعين”.فمثلاً إذا كسر رجل عظمة لرجل آخر سيكون جزاؤه أن تكسر هذه العظمة.

10. In Greece: The first surgical training program was applied
In china : The first use of anesthesia for surgical procedures, using a combination of wine and a form of cannabis
In Greece: The first surgical training program was applied
In Rome: The birth of the operating tent.
In Islamic Medicine:
The first surgical suites has been built.
Abu Baker al-Razi was the first person to introduce the use of alcohol for medical purposes. and also, was an expert surgeon and the first to use opium for anesthesia.

12. Operation tent

13. Operation tent

14. أبو بكر الرازى

16. Introduction:
Related medical and surgical terms
According to WHO Health is
" A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity."

17. Optimal Health:
" Is the best an individual can feel and function in the particular circumstances."
Disease:
" Is the failure of the adaptive mechanism to stresses, resulting in disturbance in function or structure of any organ or system of the body."
Illness:
" State of discomfort that results when disease, deterioration, or injury impairs person’s health"

18. Surgical intervention:
" Is a therapeutic process to maintain health."
Surgery:
"Is a branch of medicine that encompasses preoperational preparation, intra operative management and postoperative care of pt.

19. Surgery as a branch of medicine deals with operative procedure for:
Correction of deformities and defects.
Repair of injuries.
Diagnosis and cure of disease process.
Relief of suffering and prolongation of life.

21. Surgical technology
The number of operations performed increase that is related to:
Increased number of population.
Increased incidence of trauma and congenital deformities.
Increasing number of aged persons with degenerative disease.
Rapid progress of medical fields.

24. منظمة الصحة العالمية

25. Purposes of Surgery:
To preserve life
e.g. Relief of intestinal obstruction or decompression of skull fracture.(#)
To maintain dynamic body equilibrium
e.g. Removal of diseased kidney.
To undergo diagnostic procedures
e.g. Breast biopsy, bronchoscopy, gastroscopy.

26. Breast biopsy

29. To prevent infection and promote healing
e.g. Burn debridement.
To obtain comfort and to ensure the ability of living.
Curative
Cosmetic surgery, which reconstructs the skin and underlying structures
The types of operations performed in a hospital vary according to the expertise of surgeons and staff, the community in which the facility is located and equipment available.

30. Plastic surgery

31. Types of surgery:
Surgical procedures are commonly grouped according to:
A. Purpose
Diagnostic: Confirms or establishes a diagnosis, Example : biopsy of a mass in a breast.
Palliative: Relieves or reduces pain or symptoms of a disease, it does not cure, Example : resection of nerve roots.
Constructive Restores appearance that has been lost or reduced, Example : breast implant
Transplant: Replaces malfunctioning structures; Example : hip replacement

32. Hip replacement

34. Gall bladder stones

35. B. Degree of Urgency
Emergency Surgery:
Is performed immediately to preserve function or the life of the client. Example : surgeries to control internal hemorrhage
Elective Surgery:
Is performed when surgical intervention is the preferred treatment for a condition that is not imminently life threatening (but may ultimately threaten life or well being) or to improve the client’s life.
Example : cholecystectomy for chronic gallbladder disease, plastic surgery procedures such as breast reduction surgery

36. Degree of Risk
Major Surgery: It involves a high degree of risk, for a variety of reasons: It may be complicated or prolonged, large losses of blood may occur, vital organs may be involved, or postoperative complications may be likely.
Example : organ transplant, open heart surgery, removal of kidney
Minor Surgery; It involves little risk, produces few complications, and is often performed in a “day surgery”. Example : breast biopsy, removal of tonsils, knee surgery.

37. Phases of surgical care:
preoperative phase:
Extends to the time the pt. moved onto the operating table.
Intra-operative phrase:
Begins at this time and ends when the pt. admitted to the recovery room.
Post-operative phrase:
Continued from the immediate recovery period to complete rehabilitation

38. The safety and welfare of pts
The safety and welfare of pts. are ensured to the nurse from the moment of arrival in the operation room until departure (leaving) and transfer of the responsibility to another professional health care member.

39. Surgical technologist (ST):
Is the person who works in the operating room with surgeons, anesthesiologist, anesthetist and professional registered nurse as a member of direct care team during surgical intervention.
Operating room experience techs that no operation is minor Every operative procedure carries high risk. Safe procedure can rapidly become a catastrophic – pt. could be allergic to the medication, to anesthesia, uncontrolled bleeding, irreversible shock, sudden Cardiac arrest on operating table.

40. Surgical preference card
There is a card for each surgery and for each surgeon in this card there is:
The name of the instrument he likes and use.
The types of suture he likes.
The surgical position for each operation.
The cards are placed in a drawer in OR supervisor's office
Benefits of these cards:
keep work going smoothly.
Keep the surgeon comfortable during his work.

44. Legal issues in operating system.
Team:
"Is a group of two or more who recognize the common goals and doing their effort to achieve it."
Health care team:
"All personal relating to the pt. those in direct pt. contacts as well as those who contact with the pt. indirectly".
The team common goal:
"Is relieving of suffering restoration of bodily structure and function and favorable post op outcome.

47. Operating Room Team (personal):
When a patient is about to undergo a surgical procedure direct patient care will be pass on to the operating room personnel. The operating room OR team is responsible for the well-being of a patient throughout the operation.

49. This team should not only consider the patient’s privacy but will also promote safety measures for the patient. One way of promoting safety of patients inside the OR is by preventing infection from the surgical incision that will be done.
As described, the OR team is similar to that of a symphony orchestra. There are many members in an orchestra but they work together in union and harmony to create an interesting outcome.  

50. The operating room team does the same thing
The operating room team does the same thing. They coordinate their work with each other to have a successful operation.

51. Expected behavior of OR nursing personal:
Empathic:
These persons have Intuitive awareness of what the patient is experiencing (feeling similarly like the pt.).
Conscientious
These persons will not compromise or sacrifice principles of self – accountability.
Efficient and well - organized:
Persons who develop organized work habits know that pts. are properly prepared

52. Flexible and adaptable:
OR team members react quickly to changing in a calm manner.
Understanding, Reassuring and Supportive:
Team members allow others to express their feelings this coveys to pts. that the team's ability to relieve physical and emotional discomfort.
Skilled listener, Observer and Communicator:
These persons who listen and look will act effectively.
Considerate:
These persons respect other people's concepts.
Objective:
These persons get assemble data before making judgment and they view the situation form all sides before taking action.
Readiness:
OR team are ready to their operations with the required equipment and they are prepared for the unexpected

53. All personal involved in caring for surgical pts
All personal involved in caring for surgical pts. during the critical intraoperative phase must be familiar not only with policies, procedure and surgeon's routine, but also with equipment.

54. Members direct surgical pt. care:
OR Personal
Members direct surgical pt. care:
Surgeons.
Assistants the surgeons.
Scrub nurses.
Circulating nurses.
Anesthetists.
They must be familiar with procedures, equipment, policies, and able to cope with unexpected situation.

55. Classification of OR team
There are two types of OR team according to the functions of its members.
Sterile Team Members
Surgeon
Assistants to the surgeon
Scrub person (either a registered nurse or surgical technologist)

57. Un sterile team members
Anesthesiologist
Circulator
Biomedical technicians, radiology technicians or other staff that might be needed to set up and operate specialized equipment or devices essential in monitoring the patient during a surgical operation

58. Anesthesiologist and Anesthetist:
Anesthesiologist: Who specialized in the art and administering the anesthesia.( A physician)
Anesthetist: Is a person not necessary a physician to administer the anesthesia like qualified nurse.

59. The main activities of the anesthesia provider
Monitoring vital functions and parameters
Fluid and electrolyte administration
Administering anesthetic agent.
Maintaining anesthesia at the required levels
Managing untoward reactions to anesthesia throughout the surgical procedure.

60. Circulating nurse:
He plays a great role before, during and after the operation because most pts. are unconscious, sedated, powerless, unable to make decision at this time pts. need the professional judgment of others who must function on their behalf.

67. The surgeon is the in-charge at the operation table but the circulate nurse is monitoring and coordinate activities within the room and to manage the Nsg care required for each pt.

68. Role of Circulating Nurse:
Assist the surgical team with sterile draping of client
Maintaining the safe and comfortable environment for the pt.
Performs surgical hand scrub .
They assist the scrub to wear their gowns and gloves and help them as they enter the operating room
Prepare sterile field with procedure appropriate supplies and instruments, check to make sure all instruments work properly

69. Must be alert to catch any breaks of sterile field that others may not have seen.
Must know all supplies, instrument and equipment and able to get them quickly.
They initiate the counting of sponge, sharps and instruments before incision is made, at the beginning of wound closure and at the end of the surgical procedure
Handles surgical specimens per institutional policy
Maintains of the communication link between the OR team at sterile field and persons not in OR like (pathology, old bank, x ray).

70. The circulate nurse is the most experienced Nsg team member in the OR, acts as supervisor advisor and teacher.
Wipes the surgeons' brows as needed .
Adjusts the surgical lights, attaches the suction apparatus and check to see its function
Accompanies the patient to the recovery room.
Job descriptions:
Each OR staff member must understand his/her own function and responsibilities and must be written by each hospital to plan and coordinate the work.

71. Physical layout of OR department:
Each department (suite) is designed on an individual basis to meet projected, specific future needs.
The number of rooms required depends on:
Number of operations and length to be performed.
Type and distribution by specialties of surgical staff.
Proportion of elective inpatient and ambulatory pt. to emergency operation.
Number of hrs./day and days/wk. the dept. will be use.

72. Location of OR suite:
The OR suite is usually located in an area near to critical care surgical pt. areas and the supporting service department e.g. the central sterilization department, pathology and radiology.